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Lead Extractions and Lead Management

What is it?

For patients with a pacemaker or an implantable cardioverter defibrillator (ICD) that malfunctions, their physician may recommend a lead extraction. A lead is a thin, flexible wire that is threaded through a vein in the chest and connected inside the heart. The leads help deliver energy to the heart muscle from a pacemaker or ICD, which helps keep the heart beating at a normal rhythm. Most people with pacemakers and ICDs have two or three leads implanted. When leads are first implanted within the heart, they can be removed easily. Over time, however, scar tissue grows around the leads, and they become difficult to remove. If the area around the leads becomes infected, blocked or damaged, it can result in mechanical problems and the leads may have to be replaced. If scar tissue has grown around the leads, they must be removed by a heart rhythm specialist using a procedure called lead extraction.

Most often, cardiologists will extract the leads through the subclavian vein using a small incision in the upper part of the chest (just below the collarbone). When it isn’t possible to use this approach, they will use the femoral approach, removing the lead through the femoral vein after making a small puncture in the groin area.

During the procedure, the cardiologist places a sheath into the vein and threads it over the lead, attaching the sheath to the tip of the lead where it attaches to the heart. The cardiologist then breaks up the scar tissue around the lead by using a laser or a tiny pointed tip that allows the lead to be removed.

Whenever possible, the cardiologist will implant new leads during the procedure. There are times, however, when the physician will opt to re-implant the leads at a later date. For example, if there is an infection at the lead site, this infection will have to heal before the cardiologist can safely implant new leads. In that case, a second procedure may be necessary once the infection has cleared.

The Loyola difference

Loyola serves as a major regional and national referral center for the treatment of atrial fibrillation, offering treatment options often unavailable elsewhere. Our skilled team of leading electrophysiologists, advanced practice nurses, technical staff, imaging experts and other professionals provides an integrated approach to the diagnosis and treatment of a variety of rhythm disturbances and their associated underlying conditions.